September 2019 HSC Section 1 Congenital and Pediatric Problems

Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2018; 107:140-144.

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Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology

journal homepage: www.elsevier.com/locate/ijporl

A randomized study of four di ff erent types of tympanostomy ventilation tubes – Full-term follow-up Johan Knutsson a , b , c , ∗ , Claudia Priwin d , Anne-Charlotte Hessén-Söderman e , f , Andreas Rosenblad b , Magnus von Unge a , b , g a Dept of Otorhinolaryngology, Västmanland County Hospital, Sweden b Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden c Dept of Otolaryngology, Örebro University Hospital, Sweden d Dept of Otorhinolaryngology, Sophiahemmet University, Stockholm, Sweden e Dept of Otorhinolaryngology, Cityakuten, Stockholm, Sweden f Division of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden g Dept of Otorhinolaryngology, Akershus University Hospital and University of Oslo, Campus Ahus, Oslo, Norway

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A R T I C L E I N F O

A B S T R A C T

Objective: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fl uoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occur- rence of persistent perforation. Methods and material: Four di ff erent types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four speci fi c combinations of VT material (silicone or fl uoroplastic) and shape (short, double fl anged or long, single fl anged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored post- operatively every third month by an otolaryngologist. Results: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50 – 6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in sig- ni fi cantly longer time to fi rst infection in a VT ear, HR 1.68 (95% CI 1.03 – 2.76, p = 0.039). Donaldson tubes rendered the longest mean time to fi rst infection (p =0.025). Infections did not a ff ect tube extrusion rates signi fi cantly (p =0.879). No signi fi cant di ff erences were found regarding tube occlusion, tube extraction or persistent perforation. Conclusions: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render signi fi cantly longer time to fi rst infection. Donaldson tubes result in least infections. Infection does not a ff ect extrusion rates signi fi cantly. Level of evidence: 1b

Keywords: Ventilation tubes

Tympanostomy tubes Secretory otitis media

Extrusion Otorrhea Occlusion Complications Material Tympanic membrane perforation

1. Introduction

prevent rAOM and restore hearing impaired by SOM [ 3 , 4 ]. In 77% of children receiving VTs, the quality of life was improved [ 5 ]. Time to tube extrusion vary and VT treatment can result in com- plications: otorrhea; tube blockage; tympanosclerosis; and persistent tympanic membrane perforation [ 6 ]. Even though VTs are by far the most common implant in pediatric patients, the knowledge about the clinical outcomes of di ff erent types of VTs is sparse. There is a plethora of commercially available VTs, di ff ering in design and material, but very few have been tested in randomized controlled trials (RCTs). A systematic review of the literature concluded that there is a lack of

It has been estimated that more than seventy percent of all children experience at least one episode of acute otitis media [ 1 ]. Transmyr- ingeal ventilation tube (VT) insertion is a treatment option for recurrent acute otitis media (rAOM) as well as for secretory otitis media (SOM) causing hearing impairment. Insertion of VTs is one of the most common surgical procedures during childhood. It was reported that by the age of three, 6.8% of North American children had VTs inserted [ 2 ]. VT insertion may

∗ Corresponding author. Dept of Otorhinolaryngology, Västmanland County Hospital, Sweden. E-mail address: johan.knutsson@regionvastmanland.se (J. Knutsson).

https://doi.org/10.1016/j.ijporl.2018.02.012 Received 23 October 2017; Received in revised form 1 February 2018; Accepted 3 February 2018

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